POS1561-HPR HEALTH CARE PROVIDERS’ PERSPECTIVE ON CONTINUATION VERSUS TEMPORARY INTERRUPTION OF IMMUNOMODULATORY AGENTS IN CASE OF AN INFECTION: AN INTERVIEW STUDY
Authors: M. Opdam, J. E. Vriezekolk, A. Den Broeder, L. M. Verhoef
Journal: Annals of the Rheumatic Diseases (2022)

Background Immunomodulatory agents (IA) are often used in the treatment of immune mediated inflammatory diseases (IMIDs). The use of some of these IA is associated with a slightly increased infection risk (1), which raises concerns especially during the current COVID-19 pandemic. It is however unknown whether it is best to continue or temporary interrupt IA in case of an infection, and what the views of health care providers are on this subject. Objectives To obtain insight in the health care providers’ perspective regarding continuation and temporary interruption in case of an infection and to assess barriers and facilitators for both treatment strategies. Methods Health care providers, involved in the pharmacological treatment of different IMID patients, were interviewed by phone or face-to-face using semi-structured interviews. Recruitment was done using purposive sampling based on age, gender, function, specialty and affinity with the topic. Interviews were conducted until data saturation and analyzed by two researchers using inductive thematic analysis. Results Thirteen health care providers with three different functions (medical specialist, physician assistant, resident in training) from three different medical specialties (rheumatology, gastroenterology and dermatology) were interviewed. Mean age was 49 years (range 34 to 66) and the majority was female (69%). Ten main themes were constructed, yielding 77 barriers and facilitators across the two treatment strategies (see Table 1 for themes and a selection of barriers/facilitators). Health care providers mentioned that the choice between continuation and temporary interruption is often about balancing infection severity, IMID severity (e.g. risk of flare) and patient characteristics (comorbidities/vulnerability). They struggled with the lack of evidence on these two treatment strategies, which leads to choices being made based on previous experiences or intuition. Table 1. Identified themes Theme Example of barrier/facilitator 1. IMID characteristics Low disease activity (facilitator for interruption) 2. IA characteristics Large administration intervals: interruption not possible (barrier for interruption) 3. Effects of IA on infection / immune system Belief on positive effect (facilitator for continuation) 4. Patient characteristics Patients with comorbidities / history of previous infections (facilitator for interruption) 5. Infection characteristics Mild infection (facilitator for continuation) 6. Guidelines / current practice Current practice = interruption of IA during infection (barrier for continuation) 7. Health care provider characteristics Peer influence (facilitator for interruption; health care providers state that they would interrupt IA if for example an infectious diseases specialist would recommend so) 8. Financial Higher costs (barrier for continuation) 9. Stopping IA in general Chance to stop/taper IA (facilitator for interruption) 10. Interruption characteristics Short duration: no impact on disease activity (facilitator for interruption) Conclusion A wide variety of barriers and facilitators for temporary interruption and continuation of IA during infection were identified. These perceived barriers and facilitators –together with emerging evidence on the risk and benefits of IA use during infections (2)– will aid implementation of the most optimal strategy regarding IMIDs, IA and infections. References [1]Singh JA, Cameron C, Noorbaloochi S, Cullis T, Tucker M, Christensen R, et al. Risk of serious infection in biological treatment of patients with rheumatoid arthritis: a systematic review and meta-analysis. Lancet. 2015;386(9990):258-65. [2]COntinuation Versus Interruption of Immunomodulating Drugs in case of an Infectious disease in IMID patients (COVID I2 study), with special attention for COVID 19: a pragmatic, explorative randomized controlled trial. [Internet]. [cited 2021 Jan 21]. Available from: https://www.trialregister.nl/trial/8922 . Disclosure of Interests Merel Opdam: None declared, Johanna E. Vriezekolk: None declared, Alfons den Broeder Grant/research support from: Grants for quality of care projects and research outside the current study from Abbvie, Galapagos, Pfizer, Novartis, Lilly, Sanofi, Gilead (to the institution/rheumatology department), L.M. Verhoef: None declared